scholarly journals Examination of psychological risk factors for chronic pain following cardiac surgery: protocol for a prospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022995
Author(s):  
Michael H McGillion ◽  
Shaunattonie Henry ◽  
Jason W Busse ◽  
Carley Ouellette ◽  
Joel Katz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Short Form ◽  
Artery Bypass ◽  
Outcome Data ◽  
Life Years ◽  
Chronic Postsurgical Pain ◽  
Gender Based ◽  
And Gender ◽  
The Impact

IntroductionApproximately 400 000 Americans and 36 000 Canadians undergo cardiac surgery annually, and up to 56% will develop chronic postsurgical pain (CPSP). The primary aim of this study is to explore the association of pain-related beliefs and gender-based pain expectations on the development of CPSP. Secondary goals are to: (A) explore risk factors for poor functional status and patient-level cost of illness from a societal perspective up to 12 months following cardiac surgery; and (B) determine the impact of CPSP on quality-adjusted life years (QALYs) borne by cardiac surgery, in addition to the incremental cost for one additional QALY gained, among those who develop CPSP compared with those who do not.Methods and analysesIn this prospective cohort study, 1250 adults undergoing cardiac surgery, including coronary artery bypass grafting and open-heart procedures, will be recruited over a 3-year period. Putative risk factors for CPSP will be captured prior to surgery, at postoperative day 3 (in hospital) and day 30 (at home). Outcome data will be collected via telephone interview at 6-month and 12-month follow-up. We will employ generalised estimating equations to model the primary (CPSP) and secondary outcomes (function and cost) while adjusting for prespecified model covariates. QALYs will be estimated by converting data from the Short Form-12 (version 2) to a utility score.Ethics and disseminationThis protocol has been approved by the responsible bodies at each of the hospital sites, and study enrolment began May 2015. We will disseminate our results through CardiacPain.Net, a web-based knowledge dissemination platform, presentation at international conferences and publications in scientific journals.Trial registration numberNCT01842568.

scholarly journals 1232 Trust-Wide Assessment of Delirium in Post-Operative Elective Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Sundar ◽  
S Biggs ◽  
M Abraham ◽  
J Cook ◽  
N Watts ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Patient Outcomes ◽  
Assessment Tool ◽  
Elective Surgery ◽  
Outcome Data ◽  
Positive Screen ◽  
Acute Change ◽  
Delirium Management ◽  
The Impact

Abstract Aim Delirium is an acute change in cognition and associated with adverse patient outcomes. The incidence of post-operative delirium after elective non-cardiac surgery is unknown. We aimed to assess the incidence of post-operative delirium in this group and the effect on patient outcomes. Method Patients aged 65 and over who underwent elective non-cardiac surgery were identified on post-operative day three. Delirium screening was performed in real time using the validated 4-AT assessment tool. A retrospective review of the patients’ preoperative and perioperative record was conducted to collect demographics and identify risk factors for delirium. Outcome data was collected at 30 days. Patients with a positive delirium score (>4) underwent a more in-depth assessment and managing teams given a delirium management pack. Results 75 (39 male) consecutive patients were screened over a period of 4 months. Median age 77 years and 18% had frailty assessed as “vulnerable”. The majority of patients (37.3%) underwent thoracic surgery, followed by hepatobiliary (17.3%), gynaecological (17.3%), colorectal (12%), maxillofacial (9.3%) and ENT (4%). 5.3% (4) of patients had a positive 4-AT screen. No patients had a formal delirium screen or diagnosis in the initial 48 hours. The median length of stay for patients with a positive screen was 8.5 days (IQR 7.5-12) compared to 8 days (IQR 5-13) for patients with a negative screen. Conclusions Reassuringly, rate of post-operative delirium following elective operations in our Trust are low (5%). Larger numbers of patients are required to assess the impact this has on patient outcomes and identify correlation with risk factors.

scholarly journals Custody and Care of Children in Spain: Can the Two Rights be Reconciled?

2021 ◽  
Author(s):  
Marcela Jabbaz Churba
Keyword(s):  
Gender Gap ◽  
Gender Stereotypes ◽  
Parental Authority ◽  
Decision Making Process ◽  
Gender Based Violence ◽  
Judicial Process ◽  
Gender Based ◽  
And Gender ◽  
Children’S Voices ◽  
The Impact

AbstractThis study aims to analyse the legal decision-making process in the Community of Valencia (Spain) regarding contentious divorces particularly with respect to parental authority (patria potestas), custody and visiting arrangements for children, and the opinions of mothers and fathers on the impact these judicial measures have had on their lives. It also considers the biases in these decisions produced by privileging the rights of the adults over those of the children. Three particular moments are studied: (1) the situation before the break-up, focusing on the invisible gender gap in care; (2) the judicial process, where we observe the impact of hidden gender-based violence and gender stereotypes; and (3) the situation post-decision, showing how any existing violence continues after divorce, by means of parental authority. The concept of ‘motherhood under threat’ is placed at the centre of these issues, where children’s voices are given the least attention.

Abstract 260: Restructuring a Failed Cardiac Surgery Program in an Under Served Minority Population County

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Jamie Brown ◽  
Murtaza Dawood ◽  
James S Gammie ◽  
Patrick Odonkor ◽  
Imran Siddiqi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Access To Health Care ◽  
Planning Process ◽  
Artery Bypass ◽  
Surgical Care ◽  
Cardiovascular Death ◽  
Outcome Data ◽  
National Database ◽  
Minority Population ◽  
Strict Adherence

Objectives: Fifty years ago, Donabedian described the conceptual framework for quality in healthcare as the triad of process, structure and outcome. These principals were applied to a failed urban cardiac surgery program (volume, efficiency, and quality) in an underserved county of 900,000 people in which cardiovascular death rates are up to double the neighboring county and public health studies demonstrate high rates of cardio metabolic syndrome as well as poor access to health care. Using Cardiac Surgery as a highly measured clinical service model our hypothesis was that strict attention to all details related to Donabedian’s triad would achieve acceptable quality of care in Cardiac Surgery. Methods: The 205 patients undergoing coronary artery bypass (CAB) formed the study group. We performed a preliminary 6 month planning process evaluating and improving equipment, human resources, facilities, and patient care protocols. Emphasis was placed staff education. This process was facilitated and modeled through training and oversight by a medical school/academic health center. All structure and processes and of care including preoperative, intraoperative, and postoperative protocols were recreated and rehearsed prior to program re-start. Data for all cardiac operations were recorded using the Society of Thoracic Surgeons National database (STS). Results: 205 coronary consecutive artery bypasses (CAB) were performed. Medical comorbid conditions were higher than the STS national mean. However, the risk adjusted outcome data for the first 205 CAB population yielded a mortality of 0.5% (expected 2.5%; O/E= 0.20) as well as a complication rate (Table 1) lower than expected. The first STS rating was 3-star for CAB, 2017 (top 10% of >1000 cardiac programs, p<0.05) indicating strict adherence to a quality-first standard of care. Conclusions: Strict attention to the process and structure fundamentals and details of Cardiac Surgical care in an underserved at risk population can result in acceptable outcomes and quality measures at low program volume.

scholarly journals The Impact of RSV-Associated Respiratory Disease on Children in Asia

2018 ◽  
Vol 14 (03) ◽  
pp. 079-088
Author(s):  
Maduja Divarathne ◽  
Rukshan Ahamed ◽  
Faseeha Noordeen
Keyword(s):  
Risk Factors ◽  
Developing Countries ◽  
Disease Burden ◽  
Heart Diseases ◽  
Epidemiological Studies ◽  
Morbidity And Mortality ◽  
Life Years ◽  
Rsv Infection ◽  
Tract Infections ◽  
The Impact

AbstractAcute respiratory tract infections (ARTIs) are leading contributors to the global infectious disease burden, which is estimated to be 112,900,000 disability adjusted life years. Viruses contribute to the etiology of ARTIs in a big way compared with other microorganisms. Since the discovery of respiratory syncytial virus (RSV) 61 years ago, the virus has been recognized as a major cause of ARTI and hospitalization in children. The morbidity and mortality attributable to RSV infection appear to be higher in infants < 3 months and in those with known risk factors such as prematurity, chronic lung, and congenital heart diseases. Crowded living conditions, exposure to tobacco smoke, and industrial or other types of air pollution also increase the risk of RSV-associated ARTI. Many epidemiological studies have been conducted in developed countries to understand the seasonal patterns and risk factors associated with RSV infections. Dearth of information on RSV-associated morbidity and mortality in Asian and developing countries indicates the need for regional reviews to evaluate RSV-associated disease burden in these countries. Epidemiological studies including surveillance is the key to track the disease burden including risk factors, seasonality, morbidity, and mortality associated with RSV infection in these countries. These data will contribute to improve the clinical diagnosis and plan preventive strategies in resource-limited developing countries.

scholarly journals The Impact of Air Pollution (PM2.5) on Atherogenesis in Modernizing Southern versus Northern China

Atmosphere ◽  
2021 ◽  
Vol 12 (12) ◽  
pp. 1552
Author(s):  
Kamsang Woo ◽  
Changqing Lin ◽  
Yuehui Yin ◽  
Dongshuang Guo ◽  
Ping Chook ◽  
...  
Keyword(s):  
Risk Factors ◽  
Air Pollution ◽  
Northern China ◽  
Age And Gender ◽  
Carotid Imt ◽  
Southern Chinese ◽  
Northern Chinese ◽  
Traditional Risk Factors ◽  
And Gender ◽  
The Impact

To evaluate the impact of PM2.5 air pollution on atherogenic processes in modernizing Southern versus Northern China, we studied 1323 asymptomatic Chinese in Southern and Northern China in 1996–2007. PM2.5 exposure and metabolic syndrome (MS) were noted. Brachial flow-mediated dilation (endothelial function FMD) and carotid intima-media thickness (IMT) were measured by ultrasound. Although age and gender were similar, PM2.5 was higher in Northern China than in Southern China. The Northern Chinese were characterized by lower lipids, folate and vitamin B12, but higher age, blood pressures, MS and homocysteine (HC) (p = 0.0015). Brachial FMD was significantly lower and carotid IMT was significantly greater (0.68±0.13) in Northern Chinese, compared with FMD and IMT (0.57 ± 0.13, p < 0.0001) in Southern Chinese. On multivariate regression, for the overall cohort, carotid IMT was significantly related to PM2.5, independent of location and traditional risk factors (Model R2 = 0.352, F = 27.1, p < 0.0001), while FMD was inversely related to gender, age, and northern location, but not to PM2.5. In Southern Chinese, brachial FMD was inversely correlated to PM2.5, independent of age, whereas carotid IMT was significantly related to PM2.5, independent of age and gender. In Northern Chinese, brachial FMD was inversely related to gender only, but not to PM2.5, while carotid IMT was related to traditional risk factors. Despite a higher PM2.5 pollution in Northern China, PM2.5 pollution was more significantly associated with atherogenic surrogates in Southern compared to Northern Chinese. This has potential implications for atherosclerosis prevention.

Risk Factors and Outcomes Associated With Sepsis After Coronary Artery Bypass and Open Heart Valve Surgeries

2018 ◽  
Vol 22 (4) ◽  
pp. 359-368 ◽  
Author(s):  
Sergey Karamnov ◽  
Ethan Y. Brovman ◽  
Katherine J. Greco ◽  
Richard D. Urman
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
High Risk ◽  
Coronary Artery Bypass ◽  
Heart Valve ◽  
Artery Bypass ◽  
Open Heart ◽  
Postoperative Sepsis ◽  
Post Cardiac Surgery

Purpose. Sepsis causes significant morbidity and mortality after cardiac surgery and carries a significant burden on health care costs. There is a general association of increased risk of post–cardiac surgery sepsis in patients with postoperative complications. We sought to investigate significant patient and procedural risk factors and outcomes associated with sepsis after cardiac surgery. Materials and Methods. In this retrospective study, we analyzed 531 coronary artery bypass grafting and open heart valve surgery cases that developed postoperative sepsis in the National Surgical Quality Improvement Program database between 2007 and 2014. Patient-based and surgery-based parameters were analyzed for risk factors and outcomes reported in the 30 days postoperatively. The association between sepsis and patient outcomes was assessed in a propensity-matched cohort using univariable logistic regression. Results. Modifiable and nonmodifiable patient characteristics, including age >80, poor preoperative functional status, chronic diseases such as diabetes mellitus, congestive heart failure, chronic kidney disease with serum creatinine ⩾1.5, as well as serum albumin <3.5 and emergent nature of the case were associated with post–cardiac surgery sepsis. Surgical outcomes associated with sepsis included mortality (15.4% vs 4.5%), unplanned intubation (29.8% vs 8.2%), transfusion (53.4% vs 48.4%), acute kidney injury (7.1% vs 1.4%), postoperative dialysis (18.8% vs 3.5%), and return to the operating room (29.8% vs 8.2%). Conclusions. We identified multiple patient and surgical characteristics as well as postoperative outcomes associated with postoperative sepsis development in the high-risk population of patients undergoing cardiac surgery. Early identification of patients who are at high risk for postoperative sepsis can facilitate early treatment interventions.

scholarly journals Urinary Incontinence and Quality of Life in Female Patients with Obesity

2018 ◽  
Vol 40 (09) ◽  
pp. 534-539 ◽  
Author(s):  
Christiana Nygaard ◽  
Lucas Schreiner ◽  
Thiago Morsch ◽  
Rodrigo Saadi ◽  
Marina Figueiredo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Urinary Incontinence ◽  
Vaginal Delivery ◽  
Short Form ◽  
Female Patients ◽  
International Consultation ◽  
Independent Risk Factors ◽  
The Impact

Objective To analyze the prevalence of urinary incontinence (UI) in female patients with an indication for bariatric surgery, to investigate the potential risk factors and the impact on quality of life. Methods A cross-sectional study with female patients with obesity. The evaluation consisted of a structured interview, a specific study form and quality of life questionnaires. The Poisson regression was performed to identify independent risk factors related to UI. Results A total of 221 patients were enrolled; 118 of the study participants (53.4%) reported UI episodes. Mixed UI (MUI), stress UI (SUI) only, and urgency UI (UUI) only were reported by 52.5% (62), 33.9% (40) , and 13.5% (16) of these patients respectively. The prevalence of UI was increased by 47% among the women who had given birth vaginally and by 34% of the women who had entered menopause. Vaginal delivery and menopause were identified as independent risk factors related to UI. The mean International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) score was 9.36 ± 4.9. The severity of symptoms was considered moderate in 53.3% (63) of the patients with UI. Conclusion Urinary incontinence impacts quality of life negatively, and the prevalence of UI is high among obese patients. In the present study, vaginal delivery and menopause were independently associated with UI.

Impact of atrial fibrillation on in-hospital outcomes among hospitalizations for cardiac surgery: an analysis of the National Inpatient Sample

2022 ◽  
pp. jim-2021-001864
Author(s):  
Kanishk Agnihotri ◽  
Paris Charilaou ◽  
Dinesh Voruganti ◽  
Kulothungan Gunasekaran ◽  
Jawahar Mehta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Valve Replacement ◽  
Failure Time ◽  
Artery Bypass ◽  
Bypass Graft ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Hospitalization Costs ◽  
The Impact

The short-term impact of atrial fibrillation (AF) on cardiac surgery hospitalizations has been previously reported in cohorts of various sizes, but results have been variable. Using the 2005–2014 National Inpatient Sample, we identified all adult hospitalizations for cardiac surgery using the International Classification of Diseases, Ninth Revision, Clinical Modification as any procedure code and AF as any diagnosis code. We estimated the impact of AF on inpatient mortality, length of stay (LOS), and cost of hospitalization using survey-weighted, multivariable logistic, accelerated failure-time log-normal, and log-transformed linear regressions, respectively. Additionally, we exact-matched AF to non-AF hospitalizations on various confounders for the same outcomes. A total of 1,269,414 hospitalizations were noted for cardiac surgery during the study period. Coexistent AF was found in 44.9% of these hospitalizations. Overall mean age was 65.6 years, 40.9% were female, mean LOS was 11.6 days, and inpatient mortality was 4.5%. Stroke rate was lower in AF hospitalizations (1.8% vs 2.1%, p<0.001). Mortality was lower in the AF (3.9%) versus the non-AF (5%) group (exact-matched OR or emOR=0.48, 95% CI 0.29 to 0.80, p<0.001; 987 matched pairs, n=2423), with similar results after procedural stratification: isolated valve replacement/repair (emOR=0.38, p<0.001), isolated coronary artery bypass graft (CABG) (emOR=0.33, p<0.001), and CABG with valve replacement/repair (emOR=0.55, p<0.001). A 12% increase was seen in LOS in the AF subgroup (exact-matched time ratio=1.12, 95% CI 1.10 to 1.14, p<0.001) among hospitalizations which underwent valve replacement/repair with or without CABG. Hospitalizations for cardiac surgery which had coexistent AF were found to have lower inpatient mortality risk and stroke prevalence but higher LOS and hospitalization costs compared with hospitalizations without AF.

Sign in / Sign up

Export Citation Format

Share Document